A small team of doctors work in a hospice for children and young adults. The doctors are part time, have a variety of backgrounds such as general practice and paediatrics, and work partly or wholly for the hospice.
Doctors often see the same patients and families over a long period of time, as only a small number of patients are accepted at any one time. This can lead to 'feedback fatigue' amongst the patients and families. In addition, many of the patients have limited or no capacity to be able to give feedback about their doctor.
Given the very difficult circumstances many of the patients and families were facing, it was decided that the questionnaires should be sent to them by post, rather than handing them out face to face. The families could then complete the feedback in their own time.
Each doctor kept a list of the patients and families they had seen, which they gave to a member of administrative staff. They administered the feedback process independently of the doctors, keeping a record of patients and families who had been asked for feedback. They were able to make sure no family was overburdened by being approached multiple times. Along with the questionnaire, there was a covering letter explaining the process, and a photograph of the doctor to help with recognition. They also asked respondents to give free text comments, as specific examples tended to offer more helpful learning opportunities than scores alone.
The hospice used the GMC questionnaire, but made some changes to make it more suitable for the hospice population and for patients' parents and carers to use. They also made available an 'easy read' questionnaire for children, and for patients with learning disabilities. A member of staff, other than the doctor, supported each patient to fill in the questionnaire, if they were completing it at the hospice. Only a relatively small number of patients could do this, as it was an intensive process. But it made sure the feedback sample for the doctor was more representative of all their patients.
A decision was made not to seek feedback via questionnaires from families after bereavement, due to the sensitive nature of the situation and because the hospice would not know how each family was coping. The hospice offered other ways for bereaved families to give feedback. This included through user groups, Facebook groups, response cards and questionnaires in family flats. Whilst not specific to a doctor, information from these was shared, as it provided helpful learning and development opportunities.
It took around three months to collect enough responses for each doctor, due to the relatively small number of patients who they could approach for feedback. Questionnaires were returned to the administrator, so the doctor didn't see any individual responses. Doctors received an anonymised, personalised report to use at their annual appraisal. This approach was far more successful than the care team handing out forms face to face, and saw around three quarters of the questionnaires completed and returned, giving doctors between 10 and 20 responses each. It was a significant but achievable undertaking for this health care context.
